The American Medical Association (AMA) defines clinical integration as an approach aimed at facilitating coordination of patient care. The Affordable Care Act (ACA) or Obamacare incorporates provisions for this type of integration. The approach makes it easier for medical facilities to track patient care across different settings, including clinics, at home, hospitals and ambulances.
A lack of coordination affects service delivery, especially for patients with chronic illnesses. The patients are highly likely to have adverse prescription drug interactions, receive duplicate diagnostic tests and obtain conflicting care plans.
Blueprint for success
The clinical integration model helps reduce overuse and the delivery of value to patients. Some of the key factors that influence adoption by healthcare organizations include new payment models, healthcare reforms and advances in health information technology (IT). Clinical integration previously focused on creating acquisitions, mergers and other consolidations. These initiatives were aimed at contracting with payers and promoting negotiation.
More recently, healthcare organizations have been reinventing the concept of clinical integration. Systemic changes in the US healthcare system have also contributed to the rise of the concept. On the other hand, increases in costs have forced players in the sector to consider alternative models. This is aimed at improving patient outcomes. Clinical integration has been proven to contribute to superior safety levels and higher efficiency when it comes to patient-focused care.
Many policymakers consider payment reforms as a viable way to promote greater coordination. The ultimate goal for these reforms is to lower costs and boost patient outcomes.
Technological advancements also promote the adoption of clinical integration. The introduction of an advanced delivery system provides a platform to manage a vast network of information. This helps support the new reimbursement models. The system improves access to financial, administrative and clinical data. The information allows healthcare organizations to monitor costs and quality.
Health information technology (HIT) continues to evolve and meet the new requirements as well as standards. Some of the solutions introduced in the sector include data aggregation programs, health information exchanges (HIEs) and electronic medical records (EMRs). These IT solutions enable flexibility and continuous innovation.
Experts are convinced that integration is not defined by practices or principles. Also, the concept cannot be achieved within a closed system. It is continuous in nature and involves ongoing alignment across the care continuum. Key areas of alignment address issues surrounding incentives, behavior and knowledge.
When it comes to incentives, stakeholders require a clear, measurable definition of success. Any favorable outcomes should benefit both patients and healthcare organizations. This includes ambulatory surgery centers, laboratories, hospitals, pharmacies, physicians and payers. Meanwhile, the availability of information across multiple systems boost knowledge for all stakeholders.
In turn, this helps improve transparency, control and reduces financial risks. The stakeholders should use the knowledge and aligned incentives to bolster quality and efficiency. The creation of detective and preventive controls enables various players to make the right decisions where necessary.
Unlike in the past, experts do not believe that acquisitions are necessary to achieve integration. But, consolidations and acquisitions are commonplace. Organizations take this route in order to widen the referral base and leverage with payers. In addition, the acquisitions provide an efficient way to obtain in-depth patient information and dispatch orders.
However, the approach is widely viewed as a defensive measure by the healthcare entities. They use this mechanism to counter declining referrals and the potential to shift back to risk-based payment models. Yet, acquisition alone does not provide a sure-fire way for medical groups to attain better systems for exchanging information or obtain better rates with payers. They present organizations with considerable risk.
A better option to acquisitions is the creation of high-performing medical groups within an entity. These groups are known to support integration as well as sustainability in the long-term. They provide guidance and solid leadership in relation to improving efficiency, an increase in profits and adapting to new payment models. As a result, patients take advantage of improved service delivery.
Clinical integration as opposed to organizational consolidation is the key to reform. It enables healthcare entities to expand reach and scale in addition to boosting innovation.
Good governance plays a pertinent role in clinically integrated entities. However, this may be difficult for organizations with a disparate network of affiliated providers. The problem can be solved by adopting a culture of continuous quality improvement using wide-ranging tools.
As a result, entities can maintain the flow of information to different departments. Doing so enhances efficiency and facilitates bidirectional communication between management and physicians. Staff must be well informed about strategic decisions and group activities. This enables staffers, in particular physicians to provide regular feedback.
Providing adequate incentives is a great way to motivate physicians and staff. Many experts advocate the use of bonuses and higher salaries to support the values of clinical integration. Additionally, healthcare organization can augment the incentives by deploying communication systems, team collaboration, timely, and effective use of personnel.
Improving healthcare decisions
Interoperability and access to patient information is vital to the viability of integration. However, the information should cover the key details. For this reason, it is not necessary to view lifetime patient records at all times. Spending too much time sifting through a vast amount of data diverts attention from service delivery. Doing so undermines profitability, quality and patient outcomes.
Service providers require access to tools that deliver the information at specific points in the workflow. This eliminates the need to switch frames to review data and take action. The ideal tools are designed to filter data from various settings. On the other hand, the lack of clear visibility compromises the ability to take accurate decisions at the point of care. In turn, it becomes difficult for healthcare organization to achieve optimal care outcomes and revenue goals.